You see, but you do not observe

Reverend Archibald Alison recorded in his essay of 1790 the effect of the ‘sublime and the beautifulon the mind,’ and reflecting upon such Lockean association, Mavisbank presented an opportunity that could not be missed when the old Saughton Hall Asylum, cramped, urban and reekie, no longer fitted the prevailing theories of an appropriate environment in which to heal the troubled mind.[2] The death of Arbuthnot released the villa from family; children had grown up, and having scattered over seven seas, the maintenance of Mavisbank was beyond a lonely widow. Two months after Arbuthnot’s death, Mavisbank was advertised as follows in the Scotsman:[3]

May 1876 Scotsman
VERY DESIRABLE MANSION-HOUSE AND ESTATE
FOR SALE To be sold by private bargain With Entry at Martinmas next, or earlier if desired

THE MANSION- HOUSE AND ESTATE OF MAVISBANK, in the County of Mid-Lothian, the Property of the late George Clerk Arbuthnot, Esquire.

THE ESTATE comprising 150 acres or thereby, is beautifully situated on the banks of the North Esk, about 6 miles from Edinburgh and within a quarter of mile of the Stations of Polton and Loanhead on the North British Railway.

There are a small lake, stocked with Fish, a Rifle Range and a Cricket Ground on the Estate. There are also a Farm Steading erected by the late Proprietor: large stables, with Coach-Houses and Coachman’s Dwelling House; Three Lodges and a Garden and Ornamental Grounds extending to about 6 Acres, with Vineries, Stoves, Hot-Houses and all other requisites of a gentleman’s country residence.

THE MANSION-HOUSE, which is surrounded by fine old and valuable trees, contains Four Public-Rooms, Billiard-Room, Dorridor, Conservatory, Thirteen Bed-Rooms and Six Dressing-Rooms, Bath-Rooms, Closets and ample Servants’ Accommodation; Gas, Hot and Cold Water and Heating Pipes are laid over the whole House, which has been constantly occupied by the late Proprietor.

There are Episcopal Churches at Roslin and Dalkeith within three miles, and there are also several Presbyterian Churches of different denominations within easy reach. There are three posts every day, and Telegraph Offices in the Village.

The HOUSE and the Estate may be seen on Tuesdays and Fridays, from 2 to 6 pm, by Card, to be obtained from Messrs MacKenzie & Fraser W.S., 35 Frederick Street, Edinburgh, to whose hands are the Title Deeds and who will receive offers of.

Figure 1: May 1976 the Arbuthnot’s home for sale

Arbuthnot’s widow Caroline found that she could not leave Edinburgh: her attachment was spiritual for she was a most devout worshipper at St John’s church, although having never once missed a Sunday service (even after a heart attack) she has been absolutely forgotten by the church.

This writer, like the crime-writer Ian Rankin, is fascinated by Edinburgh past.[4] The body-snatching days of this writer’s family four generations back has already been shared, and the fascination with Dr Robert Knox articulated; the charismatic, one-eyed anatomist, whose craving for fresh corpses was ultimately exposed by the murderous killings of Burke and Hare. However, it is not Ian Rankin’s fictional detective, DI Rebus that returns our narrative to Mavisbank: for the fictional character that does so is Dr Sherlock Holmes, familiar world-wide for his incisive observational skills and cerebral prowess. Arthur Conan-Doyle, the doctor, spiritualist and believer in fairies, based his sleuth upon his medical tutor, the physician Dr Joseph Bell. This celebrated Edinburgh surgeon, and his Aesculapian friend, Dr George W. Balfour, brought new scientific vision to Mavisbank.

Figure 2: Mavisbank a family home is now a business venture in healing[5]

Mavisbank and the Aesculapians:
The advert above appeared in the Scotsman in autumn 1876. Mavisbank Limited: A Retreat for Mental and Nervous Individuals was a venture Aesculapian. This exclusive medical club, the very first of such clubs in the British Isles was set up by Andrew Duncan: Physician of the Enlightenment.[6]

It was Dr Andrew Duncan (1744-1828) who oversaw and organised both a Dispensary for the ‘sick poor’ of Edinburgh, and a Lunatic Asylum in which ‘inmates’ were to be treated humanely. In the face of opposition he founded a Chair of Medical Jurisprudence and Public Health in Edinburgh, the first in Britain. As a young doctor he attended the poet Robert Fergusson in his terminal illness.

The Aesculapian Club was established by Duncan in 1773 as a post-renaissance intellectual embodiment. The phoenix of this club, rose from the hearth of Robert Sibbald, the Edinburgh Physician, Antiquary and Geographer Royal who in the century before invited a band of keen, zealous friends to hold fortnightly meetings in his house. Chief among those were Doctors Balfour, Burnet, Pitcairne, and Stevenson. All had benefited from the intellectual flourish that had equally swept along Baron Clerk, with knowledge returned home from Continental instruction in the Universities of Holland, France and Italy. Of Sibbald’s party, it was Archibald Pitcairne who in 1692 became the First Professor of Medicine in the newly established College of Physicians.[7]

“Turn your mysterious Aesculapian science to increase the number of this young man’s days.”

Massinger’s tragedy, The Virgin Martyr

The Aesculapian Club, essentially a supping, or dining, club, was limited not only in numbers (ranging from 12 to 22 members in all), but also in funds. The Scottish genius for conviviality seems to have asserted itself in the constitution of this society with honorary degrees conferred by it including “Doctor of Mirth and Social Joy” and “Doctor of Merriment.” When, three years after its foundation, the members of the Club proposed to widen their interest and influence by presenting a prize for medical investigation, the proposition was made that, without infringing on the prestige of the ‘select Aesculapians’, a larger society should be instituted which would include not only Fellows of the Colleges but graduates of the University. The Harveian Society was thus a direct offshoot from the older Aesculapian Club.[8]

Figure 3: The Aesculapians – Edinburgh’s embodiment

These period Medical clubs carried a range of functions: whilst intellectually trying to instil good care amidst the less fortunate, they also pursued the conviviality of discourse. The Minute books of these meetings also reveal the prejudices of such a group at that time: in 1854 for example wagers were set at the Sydenham Club in London, “that Miss Nightingale is not married by the next meeting,” and, “that Miss Nightingale has a child by this day twelvemonth.”

It was the Edinburgh Aesculapians of the late 19th century that shaped a new future for Mavisbank. Joseph Bell, the leading surgeon of the time, and Dr George W. Balfour, the leading physician of the time, understood all too well, that they were amidst a modern epidemic: ‘Nervous disease.’ Their entrepreneurial acumen is shown in the opening words of their new Institution which was bought for £25000. Mavisbank, as a Limited Company, sought investors to match the outset capital (£25000) offering to those inclined, a market price of £1 per share. Evidently such ‘inclination’ was good as The Nervous Hospital for the ‘well-to-do’ opened the following August.

A Retreat for Mental and Nervous Invalids
There has been for some time a growing necessity for more suitable accommodation for Persons’ suffering from mental disorder and belonging to the Upper and Middle Classes of Society. Whilst in most of the Public Establishments for the treatment of the insane the benefit of the best Medical skill is obtained, the system of Mixed Classes is frequently felt to be a serious disadvantage.

Many persons are at present located in these Institutions only because of the difficulty in obtaining more suitable accommodation elsewhere; and it is believed that the friends of Patients would much prefer to place them in an Institution where the Class is more select, and where the fullest regard can be had to the comforts and amenities to which they have become accustomed at home.

Many of the leading members of the Medical Profession have expressed approval of the proposal to supply the want now referred to, and, with this view, the beautifully-situated Mansion-house and Estate of Mavisbank, about six miles from Edinburgh have been acquired at the cost of £25000. Reference is made to the subjoined Reports as to the suitability of the place for the purpose intended.

The Estate extends to about 120 Acres Imperial, and is within a quarter mile from the Railway Station of Loanhead, while the Polton Station immediately adjoins the South Lodge. The House is situated in a finely Wooded Park of between 50 and 60 Acres which contains much valuable and ornamental Timber. There are Commodious Office-Houses, including ample Stabling and Coach-house accommodation. Cow-houses, Poultry-yards &e. complete in every Department. There is a large and productive Garden, covering about Five Acres, with beautiful Flower Gardens, Vineries, Hothouses and Conservatories.

Whatever sum is required to provide suitable Furnishings, and otherwise adapt the House and Grounds to then purpose in view, can be borrowed over the Estate. From its proximity to Edinburgh, the Estate is likely to increase in value, and will always form a substantial security to the Shareholders.

In making the appointment of Resident Medical Officer, most anxious care will be taken by the Board, in conjunction with the Consulting Medical Staff, to select a Gentleman of such qualifications and standing as shall command the confidence of the Medical Profession and the Public. It is expected to have the Institution ready for the reception of Patients in May next.

Very high rates of board, frequently from £200 to £400 per annum, are paid for Patients in Private Homes, where only ordinary comforts are afforded. It is calculated that, assuming there were no more than sixty-five Patients received into this Institution, even the comparatively moderate average Board of £150 per annum, together with the Revenue from Estate produce, would, after the most liberal allowance for the maintenance of the Establishment, and Interest on Money borrowed, yield a Dividend of 10 per cent to the Shareholders. Existing Hydropathic Institutions, charging less than £150 per annum, are paying dividends ranging from 7 to 15 per cent. It is confidently believed, from the superior advantages afforded by the extent and attractiveness of the Estate, combined with moderate rates of Board, that the Institution, will, under careful management, command the confidence of the Medical Profession throughout the country, and prove not only remunerative to the Shareholders, but a great benefit to the class of Patient for whom it is intended

George Andrew, Solicitor to the Supreme Court, originally from Banffshire, who settled in Holly Cottage, Lasswade

Sir Thomas Clark – Evangelical Publisher who had joined his uncle’s business (also Thomas) in 1846. This continues today forming part of Continuum Press

John Alex Reid a Glasgow-born Advocate

Andrew Robertson who had made a fortune as an Insurance Broker

George Vair Turnbull – the largest Merchant in Leith, who in 1851 set up business with Christian Salvesen, ship-owner and broker

The Directors, Dr Charteris apart, had no medical experience, and would have been advised by the Aesculapians. Of those gathered around the Club’s dining table, it escapes record who really led the Mavisbank venture: Drs Charteris, MacDonald, Balfour and Bell were all equally brilliant and in 1876 represented the forefront – indeed were the leading four practitioners – in the Scottish Medical arena.

Professor Charteris had made his name in the care of pyrexial illness and had written various articles on the treatment of disease by climate. Among his later work, we must isolate one discovery: the therapeutic potential of salicylic acid (Aspirin). It can be said then, without any fear of exaggeration, that Charteris was the man who introduced to the world modern therapeutics.[10]

Dr George W. Balfour was the uncle of Robert Louis Stevenson (whose initials RLS should properly be recorded RLBS – for Robert Louis BALFOUR Stevenson) and it was Dr George Balfour who recommended in 1880 to his ailing nephew that to ease his tubercular cough that he should winter in Davos, Switzerland. You can be assured that this advice and Stevenson’s final journey, in the decade that followed, to Samoa in the South Seas were based upon the research of Charteris.

Telegram: 29th December 1894. To the RoyalCollege of Physicians, 9 Queen Street, Edinburgh

DR. GEORGE W. BALFOUR informs us that a telegram received from Mr. Louis Stevenson’s mother has destroyed the lingering hope which Dr. Balfour entertained that there might have been some mistake in the earlier telegrams. The great novelist is dead, but the real cause of his death cannot be known until the mail arrives next week, if then.

Figure 6: Robert Louis Balfour Stevenson and his uncle Dr George William Balfour – he relieved the senile heart

The above telegraphic appeared in the British Medical Journal above an article intriguingly entitled “THE INCREASING NERVOUSNESS OF OUR TIME.”[12]It is curious how incidental discoveries can carry relevance not just for one century, but surely centuries to follow. In this article of 1894, Professor Erb carries the widely shared view of the time; that insanity was propagating like fungal spores: as a contagion environmental. Professor Erb reminded his audience that the nineteenth century began in ‘disorder and commotion.’ France had passed through a bloody revolution which was to be followed by the excitement and exhaustion of Napoleonic adventures; restlessness, political and social, was followed by a period of calm, but, with the advancing years, industrial technology rapidly replaced manual labour. This, argued Professor Erb, explained the new nervousness, where, in his words ‘time and space seemed to be annihilated.’

Figure 7: Dr Robert Jamieson the Superintendent of Aberdeen Asylum for 40 years. He thought insanity contagious.[13]

Mavisbank, in the view of the Aesculapians, could heal through time, space and landscape. In Ancient Greece, side by side, stood the persuasion Aesculapian, with its method borne of suggestion and belief; and the doctrine Hippocratic, observational but based upon the four humours. Yet both returned to, in their healing principles, the need for cleanliness, fresh air, attractive surroundings, and where practicable, exercises. It was much later, with Galen that man looked to drugs, as we are occasionally reminded by the out-moded term ‘galenicals” in pharmacy. After Galen came the Dark Ages, and it was, according to our medical historians, ‘not until the last quarter of the 19th century that therapeutics began to take a new course.’ Here of course Charteris and his aspirin are case in point.

A favourite medical article of this writer is a review of the evolution of modern therapeutics by Sir Langdon-Brown, published in the British Medical Journal in 1945.[14] The article is neither seminal nor cutting-edge; it carries however as the most honest reminder that we can and must learn from the past and that if medicine is to heal to the best of its ability, we must add a philosophical dimension to science. The only difficulty this paper presents is which, of the many lovely quotes to highlight! It is recorded that Langdon-Brown’s speech, in its hesitancy, matched the immobility of his massive physique rather than the agility of his mind.

“But no wave of advance is without a backwash, and the early triumphs of thyroid therapy misled us into thinking the problem simpler than it has proved to be.”

“The discovery of penicillin by Fleming illustrates Pasteur’s dictum that chance enters only the mind that is prepared.”

Sir Walter Langdon-Brown died in the year after he gave this address on therapeutics, but his intellectual depth, his erudition, and his fluency of thought and expression live on in his 1938 work: Thus We are Men.[15] Reading this series of essays, one realises that Langdon-Brown was no innovator or originator, but he was, supremely, an interpreter and commentator, one to hold the balance between competing branches of medicine. It is reassuring that as doctors, we have followed some of Langdon-Brown’s wisdom, but disappointing that we have not continued as far as we might.

The path of progress is littered on either side by discarded theories and practices. In psychological medicine, therapeutics have a fairly heinous career, and it would not at all surprise this writer, doctor and practitioner, that the medicines he uses today, will in the future be regarded as backward, and possibly even, barbaric. However Langdon-Brown airs another preoccupation shared by this writer; the mistaken dichotomy which separates mind and body. In order to discover, science often simplifies. This reduction has helped biological medicine in many promising ways, and has brought great good, however it has completely ignored the complexity of life, of Man; the thinking, conscious, talking animal.

“Everything should be made as simple as possible, but not simpler.” Albert Einstein

Dr George W. Balfour (1824-1903) was a remarkable doctor, who through research for this manuscript, has revealed himself as a reminder of how medicine gains not just through heralded discoveries, but as much by practise, patient contact, and continual revision of science. In modern day this is described rightly as Evidence based.[16] However consensus must not forget the voice that is Aesculapian. Dr Balfour, always a young looking man was indefatigable; he was said to walk with an upright figure and a light step. Born in Colinton Manse where his father served as Parish Minister, he trained in Medicine in Edinburgh before completing his studies in Vienna. He was very much like today’s medical columnist Dalrymple in that his store of anecdote, history and fable, made him the favourite Aesculapian of his supping comrades. However this is simply an aside to Balfour’s true place in medicine, for no other practitioner, since the time of Harvey, progressed the understanding of heart conditions, especially the ‘senile heart.’[17] At a time when venesection and antimony were the chief interventions in the routine treatment of pneumonia, Balfour was the very first to promulgate the heresy that heroic treatment was unnecessary, harmful, and often fatal.[18]

April 1895 – Edinburgh Medical Journal
Dr. George W. Balfour gives a gruesome account of the “heroic” bloodletting which our forefathers thought to be a cure for all earthly ills – over 9 pints and sometimes even more were occasionally taken from one person. The floors of hospital out-patient rooms used to be so slippery with blood that caution had to be exercised in walking over them.

However Mavisbank was attended not just by Balfour, his Physician colleague, Dr Angus MacDonald (1836-1886), also Consultant in Edinburgh’s Royal Infirmary, shared in the venture.[19] This writer, a hundred years apart he may be, shares shoelaces with MacDonald, in that both have been shaped in Aberdeen and Edinburgh, and both gained degrees in Science and Arts in the Universities of both cities. There the similarity ends! Angus MacDonald was, without any argument, the brightest star of his generation, all the more remarkable, when you consider that he sprang from working Doric roots and that his road-sweeping father died in Aberdeen when Angus was just 11 years old. In considering genius, beyond the innate determination of his family roots – Baleshare island off Uist – it should not escape our attention that Macdonald was fostered by a mother ‘of character and vigorous intellect’ and Dominie, Arthur Gerrard, Schoolmaster in Grange, Banffshire. In Medicine, Angus MacDonald is celebrated more today than he would have ever accepted – few others at that time advanced obstetric care as he did. The lives saved by MacDonald are beyond realisation and is a ‘living’ legacy of which Scotland should be rightly proud.

Mention of MacDonald cannot pass by without recognising that he was not just a medic – for he was truly a ‘Lad of pairts!’ His career in the curriculum of Arts was very distinguished; he obtained prizes in Latin, Greek, mathematics, and natural philosophy; and when he took his M.A. in 1859, he was awarded the Hutton Prize for general excellence in all the branches of the curriculum. This was all the more to his credit as, during the session, he taught in the gymnasium and elsewhere at least four hours daily.

Figure 8: Truly a lad of pairts: Dr Angus MacDonald. He saved lives but his house could not match[20]

During the last four years of his life, Dr Macdonald was plagued by a recurrent lung infection. Advised by his physicians to reduce his commitments, he spent a year in the Riviera trying to recoup his health, but to no avail. He died in February 1886, aged 49 years, at his family home 29 Charlotte Square. It is a curious twist of fate that MacDonald’s home, in the century that followed, was to become the corporate offices of The National Trust for Scotland. This one of the Trusts that failed Mavisbank. As I sit here, so pathetically typing before a screen bright, there carries the stark truth of 2009, that through mismanagement and lack of foresight, the National Trust has itself approached ruin. Its Headquarters, MacDonald’s old home, are now for sale.

It was the boyishly handsome Joseph Bell that most certainly wielded his surgeon’s scalpel to redefine Mavisbank. Dr Joseph Bell, the diary of Mrs Arbuthnot recalls, was surgeon and doctor to the Arbuthnots. Reading between the lines, as all pathographers do stray, it is evident that Mrs Arbuthnot did not care for Dr Bell; and indeed after leaving Mavisbank for a New Town Apartment she decided to forgo Dr Bell and to seek the care of a former, and retired family doctor – Dr Maclaren.[21] Could it be that Mrs Arbuthnot blamed Dr Bell for turning her family home into a Mental Institution?

Dr Joseph Bell (1837-1911), after James Young Simpson pioneer of anaesthesia, is Edinburgh’s doctor celebre. In 1894, his former student, Dr Arthur Conan-Doyle wrote:

“It is most certainly to you that I owe Sherlock Holmes, and though in the stories I have the advantage of being able to place [the detective] in all sorts of dramatic positions, I do not think that his analytical work is in the least an exaggeration of some effects which I have seen you produce in the out-patient ward. Round the centre of deduction and inference and observation which I heard you inculcate I have tried to build up a man who pushed the things as far as it would go – further occasionally – and I am so glad that the result has satisfied you, who are the critic with the most right to be severe.”

Bell replied to Doyle saying: “You are yourself Sherlock Holmes and well you know it.”[22]

Figure 9: Sherlock Holmes: was he more Dr Conan-Doyle than Dr Joseph Bell?

Dr Bell was a marked figure in Edinburgh. Nearly to the end of his life he retained his buoyant and even boyish disposition. He was bright, cheerful, and happy. He came from a dynasty, generation after generation, stretching back 150 years, which had served as medical practitioners to Edinburgh. Indeed Joseph Bell’s grandfather was one of the first Aesculapians.[23] However, it was Joseph, who was truly the emblem of family brilliance; one of the most perceptive of doctors, who behind honest charm applied his mental acumen even more skilfully than his scalpel. He was recalled for his bedside manner, easing into a vernacular couthiness without hint of pretence. His frame was slight, his head always said to be carried high and he walked between beds, stiff, bristling with a ‘jerky energetic gait.’[24]

In an era when science was only beginning to establish an influence in criminal investigations, Bell can be considered a pioneer in medical forensics. Yet as an Aesculapian there was more to his ministering of care than that which is observable, quantifiable, or assuredly scientific. Further it occurs to this writer, the equation of attribution, Sherlock-Holmes = Dr Joseph Bell, can only be a mathematical reduction: a reduction that our fictional detective would have understood. Indeed in Conan-Doyle’s story Silver Blaze,[25] we are shown that what fails to happen is sometimes as important as what does happen!

“Is there anything to which you would like to draw my attention?”
“To the curious incident of the dog in the night-time.”
“The dog did nothing in the night-time.”

“That was the curious incident,” remarked Sherlock Holmes.

Likewise, what is unsaid is often as important as what is said. And what historians omit from, or do not emphasise in, their accounts of the past tells us much about the mentality of their own times, as what is recorded.

[2]Hickman, Clare (Dec 2009) Cheerful prospects and tranquil restoration: the visual experience of landscape as part of the therapeutic regime of the British asylum, 1800-60; History of Psychiatry; Vol 20, Issue 4, No 80.